Because more patients with advanced heart failure are receiving a left ventricular assist device (LVAD) as destination therapy or a bridge to transplantation, there is increasing attention on functional outcomes and quality of life after LVAD implantation. Rehabilitation providers in the acute inpatient rehabilitation setting increasingly will treat patients with an LVAD and should understand the exercise physiology, medical management, rehabilitation considerations, and outcomes after rehabilitation for patients with an LVAD. The purpose of this article is to provide the physiatrist with a comprehensive understanding of the rehabilitation of patients with advanced heart failure and LVAD implantation. Changes in relevant organ system physiology and exercise physiology after LVAD are summarized. Safety of rehabilitation and program considerations for acute inpatient rehabilitation are reviewed. Recommendations for medical management and prevention of secondary complications seen in patients with an LVAD are outlined. A discussion of outcomes after acute inpatient rehabilitation, the dual diagnosis of stroke and LVAD placement, and long-term cognitive, functional, and quality-of-life outcomes after LVAD placement is presented.

BACKGROUND: Nutrition's impact on stroke rehabilitation outcomes is controversial. Existing studies utilize albumin without correcting for inflammation in nutritional assessments. Here, prealbumin was used and inflammation assessed to determine if nutrition impacts rehabilitation outcomes. OBJECTIVE: Determine the effect of dietary intake on prealbumin level, number of complications, length of stay, and Functional Independence Measure (FIM) efficiency in rehabilitation stroke inpatients. METHODS: Patients had admission and discharge prealbumin and C-reactive protein (CRP) levels drawn; and, weekly protein and calorie counts obtained. Patients were followed for number of complications, length of stay, and FIM efficiency. RESULTS: Mean protein and calorie intake was 57.6 ± 16.2 g/d and 1452.2 ± 435.8 kcal/d, respectively. 77.6% of patients had normal prealbumin on admission with 94.9% on discharge. Prealbumin increased significantly from admission to discharge (22.3 ± 6.2 mg/dL vs. 24.6 mg/dL ± 5.1 mg/dL, P = 0.007). Number of complications and length of stay were predicted by CRP in regression models. Total, motor, and cognitive FIM efficiencies were not universally affected by prealbumin levels, protein intake, or calorie intake. CONCLUSIONS: Nearly all hypoprealbuminemic stroke rehabilitation inpatients correct their levels eating a non-supplemented diet. Number of complications, length of stay, and functional outcomes in this patient are not affected by prealbumin levels, protein intake, or calorie intake.

Objective To evaluate the effectiveness of a newly initiated aphasia center program using Life Participation Approach to Aphasia (LPAA) values. Design Evidence-based practice quality improvement project. Setting Ambulatory care aphasia center part of a larger health care system. Participants Participants included 41 clients with aphasia and 40 primary caregivers of clients with aphasia. Participants included all clients and caregivers that were enrolled in the aphasia center within the first year of opening. All participants were enrolled in 1-4 eleven-week sessions of the aphasia center program. Participants with aphasia included 19 women and 22 men with a mean age of 65.2 years (range, 33-84 years). Interventions Group therapy was provided using the LPAA statement of values with each client receiving 3 hours of treatment once per week for 11 weeks. Clients were provided with the opportunity to complete multiple 11-week enrollment sessions if they chose to do so. Main Outcome Measures Client-reported outcomes included the Stroke and Aphasia Quality of Life Scale, and caregiver-reported outcomes included the Modified Caregiver Strain Index. Both measures are self-reported and scale based. Client satisfaction data were also collected via a self-reported program evaluation upon completion of each 11-week session. Results Results indicated statistically significant improvements in quality of life scores for clients with aphasia following initial participation of an 11-week aphasia center program ( P ≤.0001) and following 1-year participation ( P ≤.0001). Additionally, caregiver’s level of burden decreased significantly following initial participation of the family member ( P =.003) and following completion of three 11-week sessions ( P ≤.0001). Self-reported client satisfaction program evaluation results also demonstrated improved quality of life (100%) and improved language skills (average=89.75%). Conclusions The project provided further evidence supporting the use of LPAA values with clients experiencing chronic aphasia.